Morphometric endoscopic study of the pharynx in patients with sleep apnea

• Published in: American journal of otolaryngology Vol. 33; no. 3; pp. 332 - 337
• Main Authors: da Silva, Sávio Nogueira, MD, Faria, Ana Célia, DDS, Garcia, Luis Vicente, MD, de Mello-Filho, Francisco Veríssimo, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Laryngoscopy - methods; Male; Medical sciences; Middle Aged; Otolaryngology; Otorhinolaryngology. Stomatology; Pharynx - pathology; Pneumology; Polysomnography; Respiratory system : syndromes and miscellaneous diseases; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - physiopathology; Surgery; Wakefulness; Human; Nervous system diseases; Sleep apnea syndrome; Respiratory disease; ENT; Endoscopy; Pharynx
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2011.10.005

Abstract Purpose The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed. Materials and Methods Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another. Results The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%). Conclusions The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx.